Re: Clonus

Posted By CCF MD mdf on March 11, 1998 at 11:17:35:

In Reply to: Clonus posted by Alva on February 28, 1998 at 15:09:17:







: : : What can cause rampant clonus?
9 years ago (1989) I was clinically diagnosed w/ MS at Mayo in Jax. They found a small something on the conus and suspected an AV malformation. They did an angiogram and ruled out the AV malformation. My symptoms were leg pain, bladder hesitancy, post-voiding residual, and what I thought was a small tremor in the rt hand. (I had already had a L5S1 discectomy)
In 1991, trigeminal neuralgia started as well as a lot of clonus in rt hand. Later Glosso-pharangeal neuralgia and rt. hand - arm - shoulder weakness.
Now I have clonus everywhere, both sides of jaw, both hands, arms, feet. Clonus in arms so bad I beat my haed w/ phone. I take 20 mg baclofen X3, 300 mg neurontin X 3, 50 mg Zoloft. This puts the clonus in a state that it will stop after a few seconds.
Current MRI's on brand new equipment which show no problem w/ CNS. Lumbar shows 3 herniated discs, none pressing on the cord. Cervical shows an anterior herniation at c5-6, not pressing on anything. EMG's say that it's central. No problem on evolked responses.
Where can the problem lie? Is clonus a symptom or a separate condition by itself? Is it found as a feature of diseases other than MS?
Hi Chery!!
I am a paraplegic and I also have clonus....I was hospitalized for 4 months in the Rehab Unit of a local hospital..The doctors there and the therapist told me that the clonus in both legs...When I asked what was causing that they told me that that was a sign of a spinal cord injury...Try telling that to your doctor and maybe it will give him some clue or maybe another test like CT, MRI or a Myleogram(sp?)...What ever you decide to do...I would at least tell your doctor what I told you....Good luck and I hope your medical problems are resolved quickly...Sincerely, Alva
Hi Chery!!
it is me again...I am so sorry for the post I made in reference to you article about CLONUS...when I reread the info I typed in...I could not believe all of the mistakes...I hope you were able to get passed the errors and make some sense of what I said...If you would like to ask me anything...Please, feel free to email me...Thank you for being so understanding....Sincerely, Alva
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Clonus is a reflection of exaggerated deep tendon reflexes.
Here is how it works. There is an apparatus in your muscles which senses the amount of stretch. That information is transmitted to the spinal cord for processing. If the stretch increases rapidly, the spinal cord circuitry sends a signal to the muscle to contract. This is the typical deep tendon reflex which you see when the doctor taps your knee with the hammer.
The sensitivity to stretch and the force of the reflex contraction depend on a number of factors, including the integrity of the muscle, the nerve, and the spinal cord circuitry itself. If those parts are damaged, then the reflex may be diminished. For example, with certain "pinched nerve" conditions, one of the reflexes may be less brisk than the others when the doctor tests it.
Additionally, the force of contraction depends on controlling signals from above. The brain sends inhibitory influences to the circuitry at that spinal cord segment. If the relevant part of the brain is somehow disconnected from the reflex circuit, then the reflex may actually be increased because of the lack of inhibition from above.
If certain parts of the brain are damaged, or if the spinal cord above the segment containing the reflex circuitry is damaged, the reflex will be increased. Clonus is this in the extreme, where you get a repetitive contraction/relaxation, like a reverberation.
Increased reflexes (and clonus) may be found in a variety of conditions, from mechanical compression injuries of the spinal cord, loss of myelin "insulation" around the bundles of fibers carrying these signals (as in MS), strokes, and so forth.
Your symptoms are quite consistent with MS, as you describe symptoms related to multiple locations in the central nervous system (brain and spinal cord) evolving over time. The disc bulges are probably irrelevant if, as you say, there is truly nothing pressing on the cord. If you desire a second opinion, there is a very capable group of MS experts here at the Mellen Center at the Cleveland Clinic Foundation.
I hope this helps.  CCF MD mdf.